HMSA Gold PPO I
HMSA · 2026 plan year
Gold
- Ind. deductible
- $700
- Family deductible
- $1,400
- Ind. OOP max
- $8,200
- Family OOP max
- $16,400
Compare with other Gold plans in HI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More HMSA plans in HI
Monthly premiums by age
Rating Area 1
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $394 | $394 |
| 21 | $515 | $619 |
| 30 | $585 | $702 |
| 40 | $659 | $790 |
| 50 | $921 | $1,105 |
| 60 | $1,399 | $1,679 |
| 64 and over | $1,546 | $1,856 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 20.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 20.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 20.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $45.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | $50.00 |
| Preferred Brand Drugs | $30.00 |
| Specialty Drugs | $200.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 20.00% |
| Mental/Behavioral Health Outpatient Services | $30.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | 20.00% Coinsurance after deductible |
| Accidental Dental | 20.00% Coinsurance after deductible |
| Acupuncture | Not covered |
| Allergy Testing | 20.00% Coinsurance after deductible |
| Applied Behavior Analysis Based Therapies | 20.00% Coinsurance after deductible |
| Autism Spectrum Disorders | 20.00% Coinsurance after deductible |
| Bariatric Surgery | 20.00% Coinsurance after deductible |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 20.00% Coinsurance after deductible |
| Chiropractic Care | $20.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | 20.00% Coinsurance after deductible |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | No charge |
| Dialysis | 20.00% Coinsurance after deductible |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 20.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 20.00% Coinsurance after deductible |
| Habilitation Services | 20.00% Coinsurance after deductible |
| Hearing Aids | 20.00% Coinsurance after deductible |
| Home Health Care Services | 20.00% Coinsurance after deductible |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | 20.00% Coinsurance after deductible |
| Infertility Treatment | 20.00% Coinsurance after deductible |
| Infusion Therapy | 20.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 20.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 20.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | No charge |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Orthodontic Services to Treat Orofacial Anomalies | No charge |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $30.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 20.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $30.00 |
| Prenatal and Postnatal Care | 20.00% Coinsurance after deductible |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | 20.00% Coinsurance after deductible |
| Reconstructive Surgery | 20.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30.00 |
| Rehabilitative Speech Therapy | $30.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | $10.00 |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 20.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| Telehealth | $30.00 |
| Transplant | No charge |
| Treatment for Temporomandibular Joint Disorders | Not covered |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 20.00% Coinsurance after deductible |
Plan rules
Service area
This plan covers 1 geographic area.
Open enrollment coming up?
Get notified when it opens — we'll remind you so you don't miss your window.